Abstracts

Rationale: Disrobing has long been recognized as behavior associated with seizures in some patients with partial onset epilepsy. Little is known about the clinical aspects and medical-legal consequences of this syndrome.Methods: We retrospectively reviewed the clinical presentation, localization, and forensic consequences in a series of patients with ictal, postictal, and coincidental disrobing. The setting is the University of Colorado Comprehensive Epilepsy Center, a tertiary referral center in the Rocky Mountain region. Patients were identified through clinical queries and consent, gathered from the 4 epileptologists in the group.Results: We collected 12 patients with disrobing associated with epileptic seizures. Eight appeared to have them ictally or in the immediate post-ictal period. With 2/8 it occurred with most of their seizures. With the other 6/8 it was more sporadic. Of the entire series, 6 were actually monitored in our Epilepsy Monitoring Unit, and 1 was observed to disrobe repeatedly. All of these 6 patients had temporal lobe onset seizures (4 right sided, 2 left sided). Two of the remaining 6 patients had mild-moderate developmental delay and likely frontal onset seizures. Unfortunately, they were not monitored. Four of the patients reported episodes where disrobing was coincidental with the seizure. For example, they were showering at the time of the seizure, and wandered into public areas (1 was recurrent, 3 were sporadic). Finally, 2 patients had significant legal complications as a result of disrobing in public, and a third patient lost her job.Conclusions: Disrobing can occur as either an ictal automatism or during the postictal period. Some patients have seizures when already unclothed and then wander into public areas. Most of our patients with ictal disrobing had a mesial temporal focus, but this likely represents a selection bias. This behavior has a dramatic effect on patient's quality of life and has the potential for unintended and significant legal consequences.